Oftalʹmologiâ (Dec 2021)
Efficiency and Safety of Binocular Cataract Phacoemulsification
Abstract
A literature review is presented on the comparative assessment of two options for conducting cataract phacoemulsification — monocular phacoemulsification of cataract, (delayed sequential bilateral cataract surgery, DSBCS) and binocular phacoemulsification of cataract (immediate sequential bilateral cataract surgery, ISBCS). It has been established that to date in the literature there is a sufficient amount of data indicating the positive aspects of ISBCS, associated with faster rehabilitation, better functional results, as well as time, financial, and economic aspects. The safety of ISBCS is determined by the minimum likelihood of postoperative bilateral endophthalmitis with careful selection of patients, the required surgeon qualifications and strict adherence to the surgical protocol. Comparatively, in accordance with the results obtained, postoperative refractive indices, the value of the maximum corrected distance visual acuity, the frequency of complications and the degree of patient satisfaction were the same regardless of whether the bilateral cataract surgery was performed simultaneously or sequentially. The effectiveness of ISBCS is determined by quick rehabilitation, the need for only one pair of glasses, a decrease in visits to the clinic, the absence of anisometropia between operations, as well as only one general anesthesia (if necessary). The experience of clinics where such procedures were carried out shows that after ISBCS, minor refractive errors occur, while they are almost always symmetrical, characterized by a slight deviation from the target refraction and rapid recovery of binocular and stereoscopic vision. In financial terms, in accordance with the calculations carried out, the cost of DSBCS in various countries may be higher than the cost of ISBCS by 10.8–47.9 %. In absolute terms, simultaneous cataract surgery on two eyes (Finland) saved €449 per patient in medical costs and €739 after travel and home care costs were included. Taking into account the cost of lost work time, the savings were €849 per patient. The wider distribution of ISBCS is associated with the approval of the ophthalmological community and insurance companies, as well as the development of standardized teaching materials for practicing ophthalmologists.
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